Antidepressants and Strength of Character

There are different levels of stigma surrounding mental illness. There’s the stigma of having a disorder in itself, the stigma of being in treatment for a disorder, and, perhaps most of all, the stigma of that treatment being pharmacological.

People love to hate psychopharmacology, especially antidepressants, the efficacy of which is constantly being questioned (often for good reason). However, I’ve noticed that drugs like antidepressants receive a special type of scorn, one that cannot be based solely on the efficacy mystery.

I’ve found that where mental treatment is concerned, therapy holds some sort of moral superiority over drugs in many people’s eyes. I think many people still feel that mental disorders are spiritual illnesses, not medical ones, and that treating them with a pill is some sort of cop-out. (Imagine the public furor if researchers came up with a pill to, say, erase the feeling of guilt.)

This would explain why, though therapy is still stigmatized–after all, the Ideal Person works out these issues on his or her own–it is considerably less looked down upon than psychotropic medication. Our culture values struggle and hard work so much that even recovering from an illness should be mentally effortful.

What people don’t realize is that there are plenty of perfectly legitimate reasons why someone might choose medication over therapy, at least in the short term. Consider, for instance, the situation I found myself in a month before I began my sophomore year of college. Having spent my entire freshman year growing progressively more depressed, I’d thought that coming home for the summer would magically fix everything. It didn’t. With a month to go, I realized that I felt like I’d rather die than go back to school.

That was when I was first diagnosed with depression, and I think my psychiatrist realized, as did I, that I just didn’t have time to muck around with my feelings–I had to get better quickly, or else going back to school would be more upsetting and stressful than I could handle. So I started taking antidepressants and quickly improved enough to feel like I could deal with being in school. The mucking around with my feelings came later.

Aside from that, I can think of many other reasons medication can at times make more sense than therapy. For example:

Time. Some people are at a point in their lives where they literally can’t spare an hour or more a week for therapy. That might sound ludicrous to you, but if you’re a college student, a new parent, or a low-income worker, it probably doesn’t.

Availability. Unfortunately, not everyone lives in an area where good therapists are available and accessible (and bad therapists will do more harm than good). This is especially true for members of marginalized communities, who may have a hard time finding therapists who are sensitive to their issues. Not all therapists are as open and accepting as they should be.

Insurance. I’m lucky to have a fantastic insurance policy that covers basically everything I’ve ever needed. However, many policies are very picky with regards to therapy (as opposed to medication, which does require a prescription from a person with an MD). For instance, some policies refuse to cover therapy unless there’s an official diagnosis, and you don’t necessarily need to have a diagnosable mental disorder in order to need help. Besides, you can’t be diagnosed without going to a specialist to begin with.

Nature of the disorder. Although most mental illnesses obviously involve a psychological component, some do not. For example, many people in temperate climates get Seasonal Affective Disorder (SAD) during the winter months, which is characterized by a low-grade depression as well as various physical symptoms. It’s usually treated with antidepressants or light therapy, which actually has people sit in front of full-spectrum light.

Language. Therapy requires people to talk pretty extensively about themselves and their lives, something that would be very difficult for, say, a new immigrant who’s just learning English. Unless such people are able to find a therapist who speaks their native language, it would be pretty hard for them to get anything out of therapy.

Comfort. As a future therapist, I obviously wish that everyone were comfortable with the idea of therapy. But not everyone is. That could be because of cultural factors, family attitudes, personality, or negative experiences with therapy in the past. I think that using medication to improve your quality of life while working up the courage to see a therapist is perfectly okay.

I hope that this list shows that making decisions about mental health isn’t that different from making decisions about physical health–it has more to do with personal preferences and practical concerns than with the strength (or lack thereof) of one’s character.

Of course, I do believe that therapy is really important and generally awesome, which is why one of my upcoming posts will be about why I think that everyone (or almost everyone) should see a therapist. Stay tuned.

8 thoughts on “Antidepressants and Strength of Character”

Like you, I am open about having been in therapy and on antidepressants. In fact, I have joked that one of my hobbies is collecting DSM-IV-TR diagnoses. I often forget that my openness (including my references to my Great Depression of ’93) can make other people feel uncomfortable.

A few months ago, I lost my job — and my insurance coverage. Having been in treatment for “mental nervous disorders”, I am essentially uninsurable in the individual market. Fortunately, I was able to stockpile enough of my antidepressant to get me through the next two or three months. While sometimes I doubt that the medication is helping me at all, a close friend recently informed me that she can tell when I’ve gone off my meds.

This sentence really jumped out at me: “Our culture values struggle and hard work so much that even recovering from an illness should be mentally effortful.” I made a similar conclusion — although I didn’t express it as eloquently — when I was pregnant with my first child. For some reason that slips my mind at the moment, I decided to attempt “natural childbirth” and so took a Lamaze class. I was turned off by how the instructor seemed to think that giving birth without benefit of painkillers or other medication was a badge of honor and that any woman who even *considered* getting an epidural was selfish and evil. (I later learned that an epidural is a wonderful thing.)

As psychologically open and insightful as you are, I think that you will make a wonderful therapist. Your future clients will be lucky to have a therapist who knows what it’s like to be in the trenches.

Thank you for reading/commenting! I can definitely relate to the making people uncomfortable bit. I do feel bad when that happens, but then I remember that the more they hear it, the more they’ll get used to the shocking notion that there’s nothing shameful about having a mental illness.

I’m not planning on having children anytime soon, but I have actually thought about the whole natural childbirth phenomenon before. Although I realize that my views could change when childbirth actually becomes a reality for me, right now I think that I’m going to do whatever is most comfortable and easiest. After all, epidural or no, there’s absolutely nothing selfish or easy about having/raising children, so I don’t see why so many women have bought into the notion that they need to do thing the hardest way possible.

It reminds me of a diet book I came across once called “Skinny Bitch.” I thought it was just another diet book, but noooo. It also included bits about how you should basically never take any sort of medicine unless your life depends on it. You shouldn’t even take painkillers if you have awful period cramps, because apparently, period cramps are “Mother Nature’s way of preparing you for childbirth.” When I read that I nearly peed myself. WHAT?

I’m so glad you think I’ll make a good therapist! I hope you’re right, because I truly feel like this is my calling in life.

I think one of the areas of concern with any type of illness is that many people will first resort to pharmaceuticals before addressing any lifestyle issues, such as diet, exercise, and emotional problems. I work in the field and totally understand the need for a certain amount of access to drugs but in my opinion they are way, way over prescribed. :(

So I started taking antidepressants and quickly improved enough to feel like I could deal with being in school. The mucking around with my feelings came later.

Yup. I also think a lot of people tend to see it as an either/or approach: either one is in talk therapy or they’re on meds, which is not something that’s either true or doable for everyone. For instance, a fair number of my family members and intimate friends (and me) have anxiety disorders. I know that at least some of us have been in talk therapy to help address reasons for anxiety as well as long-term coping methods; but in terms of managing an acute anxiety attack, like, now, sometimes having access to a medication is safer for some people.

Exactly; that’s what makes me hate the judgmental attitude that many people have even more. Anyone who knows the first thing about mental health knows that, in many cases, psychologists recommend both therapy and medication together. And anyone who doesn’t know the first thing about mental health should shut up and stop judging, in my opinion. :)